PROJECT SUMMARY: Continuous physiologic monitor (CPM) overuse and resulting alarm fatigue are threats to patient safety, yet little is known about the impact of CPM alarms on hospitalized patients and families. Additionally, there are currently no guidelines for CPM use in hospitalized pediatric patients. This proposal will begin to fill those gaps. Aim 1 will assess the benefits and harms of CPMs from the perspective of hospitalized patients and families. Aim 2 will incorporate expert recommendations into an evidence-based, family informed consensus guideline for appropriate CPM use, which will be improved through testing with stakeholders. Aim 3 will pilot test the implementation of the guideline and study important contextual factors impacting implementation. The resulting guideline will inform the design of a future multi-center implementation study. Candidate: Amanda Schondelmeyer, MD, MSc is a hospital-based pediatrician whose overarching career goal is to improve the value and safety of care through the study and reduction of overuse. She is an Assistant Professor of Pediatrics in the Division of Hospital Medicine at Cincinnati Children?s Hospital Medical Center (CCHMC). She has completed a Hospital Medicine fellowship and a Master of Science in Research, as well as multiple studies of CPM use in children?s hospitals and on improving health system efficiency. The proposed career development plan builds on this training to address important skill gaps: 1) patient-centered research methods, 2) experience in guideline development and evaluation, 3) skills to conduct multi-site implementation research and 4) professional skills for conducting hospital-based research. This training will provide Dr. Schondelmeyer with critical skills to enhance her trajectory toward becoming an independent investigator. Mentors/Environment: Dr. Samir S. Shah, with expertise in multi-center research and care guidelines, and Dr. Kathleen Walsh, with expertise in patient-centered safety research, will serve as co-primary mentors on this award. The proposed career development plan utilizes the broad intellectual resources available through CCHMC and the University of Cincinnati, which are committed to supporting junior faculty members through structured opportunities for education and internal grant funding. The CCHMC Division of Hospital Medicine provides Dr. Schondelmeyer with extensive material and methodologic support including discretionary funds. Summary: This proposed innovative research will expand the evidence base for the potential harms and benefits of CPMs and involve patients and families in every step of the guideline development and implementation process. Aligned with the Agency for Healthcare Research and Quality?s (AHRQ) mission, this work will be an important contribution to improving the safety and value of care delivered to hospitalized children and their families. This award will also facilitate Dr. Schondelmeyer?s continued development into an independent investigator in the conduct of multicenter patient-centered outcomes research and a national leader in improving the value and safety of patient care through the study of overuse.